To prepare each Natural Medicines monograph, electronic searches are conducted in many databases.All literature is collected pertaining to efficacy in humans (regardless of study design, quality, or language), dosing, precautions, adverse effects, use in pregnancy/lactation, interactions, alteration of laboratory assays, and mechanism of action (in vitro, animal research, human data). Data extraction and analysis are performed by health care professionals conducting clinical work and/or research at academic centers, using standardized instruments that pertain to each monograph section (defining inclusion/exclusion criteria and analytic techniques, including validated measures of study quality). Data are verified by a second reviewer. Natural Medicines regularly monitors scientific literature and industry warnings. When clinically relevant new data emerge, best efforts are made to update content immediately. In addition, regular updates with renewed searches occur every 3-18 months, variable by topic.